Incidence and clinical features of cataracts: an under-recognized adverse event with mirvetuximab soravtansine-gynx in ovarian cancer.

OBJECTIVE

To characterize the incidence and clinical features of cataracts in patients with folate receptor α-positive recurrent high-grade serous ovarian cancer treated with mirvetuximab soravtansine-gynx, an antibody-drug conjugate targeting folate receptor 1.

METHODS

We conducted a single-center retrospective cohort study in patients treated with mirvetuximab soravtansine-gynx between February 2023 and January 2025. All patients underwent baseline and serial ophthalmologic assessments, and received prophylactic ophthalmic corticosteroids as required by mirvetuximab soravtansine-gynx US Prescribing Information. Cataracts were graded according to the Lens Opacities Classification System III.

RESULTS

A total of 108 patients were identified. Median age at mirvetuximab soravtansine-gynx initiation was 65 years (range; 37-84). Of 108 patients, 73 (67.6%) had cataracts at baseline and/or during follow-up. Among 49 patients without baseline cataracts, new cataracts developed in 14 (28.6%). Among 40 patients (excluding an additional 18 with bilateral pseudophakia and 1 with bilateral aphakia) with baseline cataracts, 9 (22.5%) indicated cataract progression. Nuclear sclerosis was the predominate cataract sub-type (20/23). Patients with new/progressive cataracts received more mirvetuximab soravtansine-gynx cycles (median, 8 vs 5) than those who did not. Non-cataract ocular toxicity rates were similar across groups.

CONCLUSIONS

Cataracts represent an under-recognized ocular adverse event associated with mirvetuximab soravtansine-gynx treatment. Although the etiology remains unclear, potentially related to mirvetuximab soravtansine-gynx exposure, ocular corticosteroids, or both, the frequency and tempo observed in this cohort underscore the need for close ophthalmologic monitoring. However, it is reassuring that cataracts can be treated with a minimally invasive procedure with generally excellent outcomes. Further research is warranted to elucidate underlying mechanisms and optimize supportive eye care strategies.